Caring for Blistered Skin
When blisters appear, the objectives of care are to reduce pain or discomfort, prevent excessive loss of body fluid, promote healing, and prevent infection.
The doctor may prescribe a mild analgesic to prevent discomfort during changes of dressings (bandages). Dressings that are sticking to the skin may be removed by soaking them off in warm water. While daily cleansing may include a bath with mild soaps, it may be more comfortable to bathe in stages where small areas are cleaned at a time.
Blisters can become quite large and create a large wound when they break. Therefore, a medical professional will likely provide instructions on how to safely break a blister in its early stages while still leaving the top skin intact to cover the underlying reddened area. One technique is to pat the blister with an alcohol pad before popping it at the sides with a sterile needle or other sterile tool. The fluid can then drain into a sterile gauze that is used to dab the blister. After opening and draining, the doctor may suggest that an antibiotic ointment be applied to the area of the blister before covering it with a sterile, non-sticking bandage. To prevent irritation of the skin from tape, a bandage can be secured with a strip of gauze that is tied around it. In milder cases of EB or where areas are difficult to keep covered, the doctor may recommend leaving a punctured blister open to the air.
A moderately moist environment promotes healing, but heavy drainage from blister areas may further irritate the skin, and an absorbent or foam dressing may be needed. There are also contact layer dressings where a mesh layer through which drainage can pass is placed on the wound and is topped by an outer absorbent layer. The doctor or other health care professional may recommend gauze or bandages that are soaked with petroleum jelly, glycerin, or moisturizing substances, or may suggest more extensive wound care bandages or products.
A number of things can be done to protect the skin from injury. These include:
• avoiding overheating by keeping rooms at an even temperature
• applying lubricants to the skin to reduce friction and keep the skin moist
• using simple, soft clothing that requires minimal handling when dressing a child
• using sheepskin on car seats and other hard surfaces
• wearing mittens at bedtime to help prevent scratching
Treating Infection
The chances of skin infection can be reduced by good nutrition, which builds the body’s defenses and promotes healing, and by careful skin care with clean hands and use of sterile materials. For added protection, the doctor may recommend antibiotic ointments and soaks.
Even in the presence of good care, it is possible for infection to develop. Signs of infection are redness and heat around an open area of skin, pus or a yellow drainage, excessive crusting on the wound.
Handle gently
Avoid lifting the new born babies from under the arm; instead , place one hand beneath the bottom and another hand beneath the head/neck to lift.
A pillow , sheepskin may be used beneath the baby to prevent friction against the skin while lifting and holding.
The clothes of the mother should be clean and with no buttons or sharp edges while having the baby in her arms to avoid any injury to the fragile skin.
Do not rub the skin
Since blisters can be caused by friction, the skin should be patted rather than rubbed.
Before making any blood analysis or tests or immunizations, the are should be cleansed y gentle pressing or patting the alcohol pad against the skin.
Dress in loose-fitting clothes
Avoid or alter clothing with binding elastic.
Avoid Harsh buttons, snaps and zippers.
Non-binding diapers or clothes diapers may be used.
Elastic may be cut from the legs of disposable diapers to help minimize blistering .
Preferable using cotton clothes .
Avoid wearing the clothes from the head , use clothes with covered buttons or zipper.
Blister care and prevention of infection
- Wash hands before administering skin care.
- Do not remove clothing or dressing that are stuck to the skin.
- Clean skin daily.
- Drain blisters , Sterile needles may be used to puncture the side of the blister roof. Take care to open the blister roof adequately and should be left intact to facilitate healing and comfort. A mild antibiotic ointment may be applied to the area to aid in the prevention of infection.
Nutrition
Breast feeing
While breast feeding which is the best for most babies presents a special challenge for infants with EB.
Infants with blisters and lesions in the mouth may have difficulty nursing or sucking from a regular baby feeding bottle. Mothers may decide to provide expressed breast milk to their babies. Mother should used a cleft palate nipple which incorporates a valve that facilitates easy delivery of the formula without the need to suck hard. This works well for babies with fragile oral mucosa.
Babies mouth care may include gentle cleansing with a spongy toothette. A dry nipple will stick to lips and blistered areas, causing more damage. A mother should moisten the nipple with water or Vaseline prior to feeding.
Do not use adhesives on the skin
Tape or bandage should not be applies to the skin because they may cause blistering .
Only use non-adhesive tape.
Apply topical antibiotics to lesion
Use Antibiotics ( Bacitracin, Fucidin cream) are effective in preventing infection and may be rotated every month or two to discourage bacterial resistance. Bactroban, like all antibiotics, should be used only when infection is present if the wound shows redness, swelling , pain or warmth.
Changing dressing daily
Daily dressing changes are recommended and can be coordinated with a bath or cleansing of the skin. Some contact layers dressings, such as Mepitel or Mepilex may be left in place for several days, although the secondary or outer dressing should be changed and the wound assessed.
Growth Chart
It is important to chart the growth of an infant/child with EB. This charts provide essential information for evaluating the adequacy of the diet. A Nutritionist should be consulted about the nutritional status of an infant with EB if there are questions or concerns about weight gain or loss. Many infants with EB require fortified formula to meet their increased caloric and protein needs or else will be anemic.
